In one startling drug study in the 1980s, a young woman who had been virtually
homebound by the energy-sapping effects of chronic fatigue syndrome had
a miraculous recovery.

But, it wasn't the drug that cured the patient – she was in the trial
group that was taking sugar pills. It was the "placebo effect," — a well-documented
phenomenon that has intrigued doctors for decades.

When patients believe a drug will help them, they sometimes heal themselves.

"She and her parents were so excited about her profound improvement,"
said Janet Dale, a staff scientist at Clinical Investigation at the National
Institute of Allergy and Infectious Diseases. "And she sustained her health
and continued to be well."

In a 1955 ground-breaking paper, "The Powerful Placebo," researcher
H.K. Beecher concluded that one-third of all patients responded to a placebo.

In later studies, when patients were told they were taking stimulants,
their blood pressure and pulse rates rose; when they thought they were
taking sleeping pills, they fell.

But the most significant research in placebos has been seen in the treatment
of pain relief. In some studies up to 75 percent of patients responded
to sugar pills, according to the Food and Drug Administration.

"Placebo groups are included in virtually every major clinical trial,
which is a testament to their importance," said Wager. "Only in the past
few years have scientists developed the tools to directly investigate how
placebos work in the human brain."

Morphine Mimics the Brain
Doctors have used the chemical opiate morphine to treat pain for two
centuries, so scientists like Wager have theorized that if morphine "mimics
what the brain does naturally, the brain must have its own internal chemical."

In the placebo study, Wager and his colleagues tested 15 volunteers
with two "pain relieving" creams — one had an active ingredient and the
other was inert. The creams looked identical and both were applied on the
forearm.

Researchers applied a thermode — or hot plate — against the skin, giving
a sequence of painful stimuli, similar to a hot cup of coffee. Volunteers
were asked to rate the pain.

During the experiment the volunteers' brain activity was monitored with
positron emission tomography (PET). Scientists were looking for differences
between reported pain and brain activity.

When the placebo cream was applied, volunteers were told "this is a
proven pain-reliever," and that it would work, explained Wager. "We wanted
to make sure to convince them so they really believed it blocked pain when
they were stimulated on the placebo-treated skin site."

The PET scans revealed activity in both the frontal cortex – the area
of the brain that controls conceptual knowledge, and in the periaqueductal
gray area –

But now, with advances in neuroscience, researchers at Columbia University
and the University of Michigan have been able to see how the placebo effect
works.

When volunteers were convinced they were receiving pain medicine, their
brains actually released natural relief, or opioids.

"It is the first time we have been able to directly observe placebo-induced
pain relief," said neuroscientist Tor Wager of Columbia University, whose
findings also showed that drug effectiveness is enhanced by the power of
the mind.

"We usually think a drug does something to you, but there are examples
in which the drug doesn't do anything unless we have the correct belief,"
he said. "You need both the chemical and faith that the drug will work."

"We're not there yet," said Wager, but this discovery could change the
treatment of pain and disease.

One day doctors might be able to determine which patients are more responsive
to placebos and use lower doses of powerful medicines that can cause side
effects and allergies.

The study, which was published in Proceedings of the National Academy
of Sciences, "is another piece of evidence that the person is not just
changing the way you say you feel, but how it is processed in the brain,"
said Wager.

The word "placebo" is Latin for "I will please." Placebos like sugar
pills, distilled water or saline solutions have been used for decades in
drug research and by doctors.

In a 1955 ground-breaking paper, "The Powerful Placebo," researcher
H.K. Beecher concluded that one-third of all patients responded to a placebo.

In later studies, when patients were told they were taking stimulants,
their blood pressure and pulse rates rose; when they thought they were
taking sleeping pills, they fell.

But the most significant research in placebos has been seen in the treatment
of pain relief. In some studies up to 75 percent of patients responded
to sugar pills, according to the Food and Drug Administration.

"Placebo groups are included in virtually every major clinical trial,
which is a testament to their importance," said Wager. "Only in the past
few years have scientists developed the tools to directly investigate how
placebos work in the human brain."

the region that governs basic responses to threat and is involved in
pain suppression.

Earlier placebo research used magnetic resonance imaging (MRI) to look
at the brain, but PET scans now let these scientists look directly at the
nerve chemistry of the brain and its opioides.

Drug companies have long known the power of placebos, according to Scientific
American.

"It is why drug companies sue each other over the right to have a purple
pill rather than a blue one?" a 2004 article asked. "Blue pills have the
connotation of sadness and couldn't possibly, to the placebo-induced mind,
make us better. It's called 'trade dress,' and the shape of the pill —
the color, the size — accounts for the efficacy of a pill sometimes as
much as what is in it."

In drug trials, scientists must inform volunteers when they are given
placebos, but some ethicists worry that when used outside research, placebos
can undermine the essential trust between patient and doctor.

Doctors Called 'Con Artists'
Some even go so far as to call doctors "con artists" for prescribing
placebos for panic attacks, migraines and other complaints.

At Winthrop-University Hospital on New York's Long Island in 1999, an
intern gave a patient complaining of pain a saline injection rather than
an active drug. The hospital's ethics committee prompted a survey published
in the Western Journal of Medicine that showed interns admitted ordering
placebos for patients 10 times over two years.

"I have no issue with using placebos with patients as long as a physician
indicates that this may be part of their practice so that a general consent
to the use of placebo is obtained," said Dr. Arthur Caplan, director of
the Center for Bioethics at the University of Pennsylvania.

Every patient needs to know the drugs they are taking if they change
doctors or move, said Caplan. Physicians also need to keep careful records
of placebo use.

"Sometimes talking to the patient and calming them down is a placebo,"
said Caplan. "Sometimes offering an aspirin can be a placebo. And many
prescription drugs carry a placebo effect."

Joan McGregor, professor of philosophy and bioethics at Arizona State
University, agrees that the mind can influence the body, citing the power
of prayer, meditation and social groups.

"We waste a lot of money on drugs and invasive therapies when we could
go in another direction," said McGregor. "We ought to be studying this
and harnessing the power of the mind."

The placebo study is a start, according to Columbia's Wager, and it
may eventually give scientists insight into why many drugs have a range
of effects on people, how drugs and other treatments work together with
psychological states, and how psychology can be effectively used in treatment.

"The human brain is not like a machine, but like a river with a lot
of ongoing processes," said Wager. "What you do when you give someone a
drug is you nudge that and produce all sorts of ripple effects."